Seizure
~Trigger: alcohol, bright light, sleep deprivation, drug change/missed, infection, exertion
~Risk Fx: CNS infection, family hx, childhood seizures, head injury
~Pre: Aura (visual.smell disturbances)
~During (abrupt): TC jerks, bite tongue, brief/prolonged, localized/generalized, symmetric/unilateral
~Post: Post-ictal confusion, lack of recall, drowsiness, HA, Todd's palsy (weakness after seizure)
First seizure
Generalized seizures
~attacks begin with abrupt loss of consciousness, caused by nearly simultanuous activation of the entire cerebral cortex
Absence/petit-mal
~pt stares blankly into space (unware of surroundings) <10sec then returned to normal as if nothing happened
~no loss of postural tone/postictal confusion
~attack ceases abruptly, pt returns to previous activity w/o post-ictal symptoms
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Myoclonic
~sudden brief, large emplitude muscle contraction involving part/entire body
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Generalized tonic-clonic/GTC/grand-mal
~tonic stiffening (often + tongue biting, apnoea, increase SNS tone/BP/HR) -> clonic (symmetric) limb jerking + apneic & cyanotic -> postictal drowsiness, deep rapid breathing +/- incontinence
~lasts 60-90secs
Focal/partial seizure
~localized discharge may spread to other parts/entire cortex
~likely to be 2^0 to localized structural lesion of the brain
~tends to be unprovoked seizures
Simple partial focal seizures
~W/o dyscognitive features
~S/S depends on focal irritation of various cortex - bizarre olfactory/gustatory hallucinations=medial temporal lobe; visual sypmtoms=occipital focus
~can be 'aura' to 2^0 generalization
Complex partial seizures
~With dyscognitive features - due to focal disharge at temporal lobe
~inability to respond to environment -> automatisms (lip smacking, repeating short phrases), visceral symptoms (rising epigastric sensation), hallucinations, memory disturbances, affective symptoms (intense fear, paranoia, depression, ectasy) --> postictal confusion
Etiology
Infection:
~meningitis, encephalitis, cerebral abscess, parasitic dx
~fever, meningism, increased ICP
Metabolic:
~decrease glucose/Na/K/Ca/Mg, uremia, hyperammonemia
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Hypomagnesemia:
~decrease irritability, agitation, confusion, myoclonus, tetany, convulsions
Uremia:
~renal failure, uremia, undergoing dialysis
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Drugs:
~barbiturate/benzodiazepine withdrawal
~meds = bupropion, imipenem, theophyline, tramadol
~abuse drugs = cocaine, amphetamines
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Refractory status epilepticus
~persistent seizure despite IVing adequate amts of 2 anti=epileptic drugs